Bone Marrow Examination Findings Among Sudanese Patients During the Sudanese Armed Conflict (April 2023 to February 2025)

Abstract

Abstract Background: Armed conflict in Sudan has severely disrupted healthcare delivery, and access to diagnostic services. Despite the increasing burden of hematological disorders, data on bone marrow examination (BME) findings in such settings remain limited. This study aimed to characterize the spectrum of BME diagnoses in Sudanese patients during a period of ongoing conflict. Methods: A retrospective cross-sectional study was conducted at Al-Mek Nimer University Hospital, including 291 patients who underwent bone marrow examination (aspiration and trephine biopsy) between April 2023 and February 2025. Data were analyzed using SPSS. Results: Hematological malignancies accounting for 64.6% of cases. Leukemia was the most common diagnosis (38.8%), particularly chronic lymphocytic leukemia (17.2%), acute lymphoblastic leukemia (11.7%), and chronic myeloid leukemia (10.3%). Non-malignant conditions represented 35.4% of cases, mainly reactive marrow changes (17.5%) and megaloblastic anemia (7.2%) being the most frequent. Most patients were aged 41–60 years (29.9%), with a slight male predominance (52.9%). Geographically, most cases originated from River Nile State (52.9%) and Khartoum State (33%). A notable proportion of patients were unemployed (58.8%), suggesting socioeconomic vulnerability. Conclusion: There is high burden of advanced hematological malignancies and reactive marrow patterns likely due to delayed access to care during conflict. Bone marrow examination remains essential diagnostic tool in resource-limited settings. Strengthening mobile diagnostic services, promoting early screening among high-risk groups—particularly the elderly and unemployed—and implementing micronutrient supplementation programs may help reduce morbidity and improve outcomes in conflict-affected populations. Keywords: Bone Marrow Examination, Hematological Malignancies, Reactive Marrow Conflict Settings, Sudan